Advantage by Sunshine Health (HMO SNP) is a 2014 Medicare Advantage Special Needs Plan plan by Advantage by Sunshine Health. This plan from Advantage by Sunshine Health works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Advantage by Sunshine Health and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage.
Advantage by Sunshine Health (HMO SNP) H5190-002 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.

2014 Medicare Special Needs Plan Details

Plan Name:

Advantage by Sunshine Health (HMO SNP)

Plan ID:

H5190-002

Special Needs Type:

Dual-Eligible

Provider:

Advantage by Sunshine Health

Plan Year:

2014

Plan Type:

Local HMO

Monthly Premium C+D:

$21.00

Coverage Area for Advantage by Sunshine Health (HMO SNP)

COMPARE AND SAVE ON MEDICARE INSURANCE

The Advantage by Sunshine Health (HMO SNP) H5190-002 is available to residents in Florida, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage.
Advantage by Sunshine Health (HMO SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

Total Ratings for Advantage by Sunshine Health (HMO SNP) H5190

2014 Overall Rating

Part C Summary Rating

Total Experience Rating

Complaints, Improvements

Total Customer Service Rating

Total Preventative Rating

Chronic And Long Term Care

Member Experience Rating for Advantage by Sunshine Health (HMO SNP)

Total Experience Rating

Getting Needed Care

Timely Care and Appointments

Customer Service

Health Care Quality

Rating of Health Plan

Care Coordination

Member Complaints, Problems Getting Service and Improvements in Health Plans

Total Rating

Members Leaving the Plan

Complaints about Health Plan

Access to Service

Performance Problems

Health Plan Quality Improvement

Customer Service Rating for Advantage by Sunshine Health (HMO SNP)

Total Customer Service Rating

Timely Decisions About Appeals

Reviewing Appeals Decisions

Call Center

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating

Breast Cancer Screening

Colorectal Cancel Screening

Cardiovascular Screening

Diabetes Care

Glaucoma Testing

Annual Flu Vaccine

Improving Physical

Improving Mental Health

Monitoring Physical Activity

Adult BMI Assessment

Ratings For Managing Chronic And Long Term Care

Total Rating

Medication Review

Functional Status Assessment

Pain Screening

Osteoporosis Management

Diabetes Care - Eye Exam

Diabetes Care - Kidney Disease

Diabetes Care - Blood Sugar

Diabetes Care - Cholesterol

Controlling Blood Pressure

Rheumatoid Arthritis

Improving Bladder Control

Reducing Risk of Falling

Plan - Cause Readmissions

Part-C Premium

Advantage by Sunshine Health plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

The Advantage by Sunshine Health (HMO SNP) plan has a monthly drug premium of $21.00 and a $310.00 drug deductible. This Advantage by Sunshine Health plan offers a $21.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Advantage by Sunshine Health above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $21.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Advantage by Sunshine Health (HMO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.20 for 75% low income subsidy $10.50 for 50% and $15.70 for 25%.

Part C Premium:

$0.00

Part D (Drug) Premium:

$21.00

Part D Supplemental Premium

$0.00

Total Part D Premium:

$21.00

Drug Deductible:

$310.00

Tiers with No Deductible:

1

Benchmark:

not below the regional benchmark

Type of Medicare Health Plan:

Enhanced Alternative

Drug Benefit Type:

Enhanced

Full LIS Premium:

$0.00

75% LIS Premium:

$5.20

50% LIS Premium:

$10.50

25% LIS Premium:

$15.70

Inital Coverage Limit:

$2850

Gap Coverage:

No Gap Coverage

Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Advantage by Sunshine Health plan covers No Gap Coverage through the gap.
No Gap Coverage means 0% of formulary drugs are covered through the gap or 15 or less brand name products are covered through the gap.